Clinical Presentation and Short- and Long-term Outcomes in Patients With Isolated Distal Deep Vein Thrombosis vs Proximal Deep Vein Thrombosis in the RIETE Registry
Authors: Behnood Bikdeli, César Caraballo, Javier Trujillo-Santos, Jean Philippe Galanaud, Pierpaolo di Micco, Vladimir Rosa, Gemma Vidal Cusidó, Sebastian Schellong, Meritxell Mellado, María del Valle Morales, Olga Gavín-Sebastián, Lucia Mazzolai, Harlan M. Krumholz, Manuel Monreal, Paolo Prandoni, Benjamin Brenner, Dominique Farge-Bancel, Raquel Barba, Laurent Bertoletti, Inna Tzoran, Abilio Reis, Marijan Bosevski, Henri Bounameaux, Radovan Malý, Peter Verhamme, Joseph A. Caprini, María Dolores Adarraga, Paloma Agudo de Blas, Jesús Aibar, Cristina Amado, Juan Ignacio Arcelus, Aitor Ballaz, Cristina Barbagelata, Manuel Barrón, Belén Barrón-Andrés, Ángeles Blanco-Molina, Fahd Beddar Chaib, Ernesto Botella, Beatriz Buño-Ramilo, Joaquín Castro, Leyre Chasco, Juan Criado, Cristina de Ancos, Javier de Miguel, Jorge del Toro, Pablo Demelo-Rodríguez, Ana María Díaz-Brasero, María del Carmen Díaz-Pedroche, José Antonio Díaz-Peromingo, Raquel Díaz-Simón, Irene Milagros Domínguez, Álvaro Dubois-Silva, José Carlos Escribano, Francis Espósito, Ana Isabel Farfán-Sedano, Carmen Fernández-Capitán, José Luis Fernández-Reyes, Ángeles Fidalgo, Carme Font, Iria Francisco, Cristina Gabara, Francisco Galeano-Valle, María Angelina García, Ferrán García-Bragado, Marta García de Herreros, Rocío García de la Garza, Covadonga García-Díaz, Aída Gil-Díaz, Mario Giménez-Suau, Covadonga Gómez-Cuervo, Enric Grau, Leticia Guirado, Javier Gutiérrez, Luis Hernández-Blasco, Luis Jara-Palomares, María Jesús Jaras, David Jiménez, Rafael Jiménez, Carmen Jiménez-Alfaro, Inés Jou, María Dolores Joya, Sara Lainez-Justo, Antonio Lalueza, Ana Latorre-Díez, José Luis Lobo, Luciano López-Jiménez, Patricia López-Miguel, Juan José López-Núñez, Raquel López-Reyes, Juan Bosco López-Sáez, Alicia Lorenzo, Olga Madridano, Ana Maestre, Pablo Javier Marchena, Mar Martín del Pozo, Francisco Martín-Martos, Diego Martínez-Urbistondo, Carmen Mella, María Isabel Mercado, Arturo Muñoz-Blanco, José Antonio Nieto, Manuel Jesús Núñez-Fernández, Mónica Olid-Velilla, Sonia Otalora, Remedios Otero, Diana Paredes-Ruiz, Pedro Parra, Virginia Parra, José María Pedrajas, María Luisa Peris, José Antonio Porras, José Portillo, Pedro Ruiz-Artacho, Nuria Ruiz-Giménez, Justo Ruiz-Ruiz, Pablo Ruiz-Sada, Giorgina Salgueiro, Rosario Sánchez-Martínez, Juan Francisco Sánchez-Muñoz-Torrero, Teresa Sancho, Silvia Soler, Beatriz Suárez-Rodríguez, José María Suriñach, Carles Tolosa, María Isabel Torres, Andrea Torres-Sánchez, Fernando Uresandi, Beatriz Valero, Reina Valle, José Felipe Varona, Carmen Vázquez-Friol, Laura Vela, Jerónimo Ramón Vela, Aurora Villalobos, Paula Villares, Carles Zamora, Cihan Ay, Stephan Nopp, Ingrid Pabinger, Matthias Engelen, Thomas Vanassche, Hugo Hyung Bok Yoo, Jana Hirmerova, Sandrine Accassat, Nassim Ait Abdallah, Alessandra Bura-Riviere, Judith Catella, Francis Couturaud, Benjamin Crichi, Philippe Debourdeau, Olivier Espitia, Nicolas Falvo, Claire Grange, Hélène Helfer, Karine Lacut, Raphael Le Mao, Isabelle Mahé, Pierre Morange, Farès Moustafa, Geraldine Poenou, Gabrielle Sarlon-Bartoli, Pierre Suchon, Isabelle Quere, Reza Nikandish, Andrei Braester, Gili Kenet, Manuela Basaglia, Franca Bilora, Cristiano Bortoluzzi, Barbara Brandolin, Maurizio Ciammaichella, Chiara Corgna, A. de Angelis, Egidio Imbalzano, Daniela Mastroiacovo, Simona Merla, Raffaele Pesavento, Fluvio Pomero, Carmine Siniscalchi, Antonella Tufano, Adriana Visonà, Ngoc Vo Hong, Beniamino Zalunardo, Dana Kigitovica, Elina Rusa, Andris Skride, Samuel Fonseca, Filipa Martins-Duarte, Jose Meireles
Journal: JAMA Cardiology (2022)

Insufficient data exist about the clinical presentation, short-term, and long-term outcomes of patients with isolated distal deep vein thrombosis (IDDVT), that is, thrombosis in infrapopliteal veins without proximal extension or pulmonary embolism (PE).To determine the clinical characteristics, short-term, and 1-year outcomes in patients with IDDVT and to compare the outcomes in unadjusted and multivariable adjusted analyses with patients who had proximal DVT.This was a multicenter, international cohort study in participating sites of the Registro Informatizado Enfermedad Tromboembólica (RIETE) registry conducted from March 1, 2001, through February 28, 2021. Patients included in this study had IDDVT. Patients with proximal DVT were identified for comparison. Patients were excluded if they had a history of asymptomatic DVT, upper-extremity DVT, coexisting PE, or COVID-19 infection.Primary outcomes were 90-day and 1-year mortality, 1-year major bleeding, and 1-year venous thromboembolism (VTE) deterioration, which was defined as subsequent development of proximal DVT or PE.A total of 33 897 patients were identified with isolated DVT (without concomitant PE); 5938 (17.5%) had IDDVT (mean [SD] age, 61 [17] years; 2975 male patients [50.1%]), and 27 959 (82.5%) had proximal DVT (mean [SD] age, 65 [18] years; 14 315 male patients [51.2%]). Compared with individuals with proximal DVT, those with IDDVT had a lower comorbidity burden but were more likely to have had recent surgery or to have received hormonal therapy. Patients with IDDVT had lower risk of 90-day mortality compared with those with proximal DVT (odds ratio [OR], 0.47; 95% CI, 0.40-0.55). Findings were similar in 1-year unadjusted analyses (hazard ratio [HR], 0.52; 95% CI, 0.46-0.59) and adjusted analyses (HR, 0.72; 95% CI, 0.64-0.82). Patients with IDDVT had a lower 1-year hazard of VTE deterioration (HR, 0.83; 95% CI, 0.69-0.99). In 1-year adjusted analyses of patients without an adverse event within the first 3 months, IDDVT was associated with lower risk of VTE deterioration (adjusted HR, 0.48; 95% CI, 0.24-0.97). By 1-year follow-up, symptoms or signs of postthrombotic syndrome were less common in patients with IDDVT (47.6% vs 60.5%).Results of this cohort study suggest that patients with IDDVT had a less ominous prognosis compared with patients with proximal DVT. Such differences were likely multifactorial, including the differences in demographics, risk factors, comorbidities, particularly for all-cause mortality, and a potential association of thrombus location with VTE deterioration and postthrombotic syndrome. Randomized clinical trials are needed to assess the optimal long-term management of IDDVT.